As part of the multi-country study on urban health, Countdown collaborations in Senegal, Zambia, Kenya, and Burkina Faso collected data around the experiences of maternal and newborn health care among women residing in urban slums.

Urban health is a pressing concern, particularly in rapidly growing cities where unplanned settlements often lack essential services. This second part of Countdown’s multi-country study on urban health sheds light on these challenges through primary data collection in four cities: Nairobi, Lusaka, Ouagadougou and Dakar. Below are the key findings and recommendations from the policy briefs.

Policy Brief: Do Residents of the Slums of African Capitals Have Access to Cesarean Sections? The Example of Dakar

In Dakar, the aim was to assess the spatial and financial accessibility of cesarean sections, and perceptions of cesarean sections among urban slum dwellers.  About three-quarters of urban slums are within 2 km of a facility that provide cesarean section.  Despite the policy of free cesarean section, there are fees associated with the procedure. These vary widely by the type of facility, resulting in most respondents saying that c-sections have a high cost. Women also expressed distrust about possible negative effects of c-section.

Study recommendations include:

1. Evaluating policies: There is a need to evaluate the free cesarean section policy in Dakar to understand the reasons why it is not fully benefiting the target population;
2. Enhancing services: Public hospitals must improve their technical capabilities and expand obstetric services to meet demand;
3. Effective communication: Better communication between health personnel and women during prenatal consultations can empower women in making informed delivery choices.

Policy Brief: Quality of Maternal and Newborn Health Services in Lusaka’s Unplanned Settlements

The goal of the study was to assess the quality of maternal and newborn health services and to understand experiences of person-centered maternity care (PCMC) among urban poor women. The overall low PCMC score (57%) indicated poor experience of childbirth care, with many women citing high costs, long waiting hours and disrespectful care. Healthcare workers reported job dissatisfaction and stress due to staff shortages, limited equipment/supplies and work overload, and assessment of facilities offering antenatal care services showed a readiness of 76%.

The policy brief provides various recommendations, highlighting the need for overall health system strengthening and:

1. Responding to the need of mothers in unplanned settlement areas by reducing the financial burden of maternity care.
2. Responding to the needs of healthcare providers by reducing workload due to high patient volumes; enhancing skills in PCMC, stress and anxiety management.

Policy Brief: Quality of Maternal and Newborn Health Services in Selected Urban Informal Settlement in Nairobi

In Nairobi, our findings highlighted a mixed picture of maternal and newborn health services. There was a fair experience of PCMC, but communication, autonomy, supportive care and pain control were unsatisfactory. While antenatal and postpartum care services are relatively well-prepared, there are significant gaps in labor and delivery services and care for small or sick newborns. Addressing these gaps could enhance the quality of maternity care through:

1. Training healthcare providers to prioritize empathy, build trust and ensure responsive care tailored to unique client needs.
2. Strengthening collaboration between public and private healthcare sectors to ensure accessible and affordable services, addressing disparities in quality of care.
3. Regular monitoring and evaluation of healthcare services to identify areas of improvement, based on client and provider feedback to enhance overall satisfaction and uptake of quality services.